| NPI | 1922705557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0998429-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 0107521-NP) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2025-06-20 |