| NPI | 1861125205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0004332-C-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 235366-30) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2022-08-09 |