| NPI | 1902933989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: CO 3605) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 3605) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-06-15 |