| NPI | 1831459692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO 772CNP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 4948-33) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2024-09-12 |