| NPI | 1851827323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0004363-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 22471) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2022-09-14 |