| NPI | 1942890686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO MSAPN.0000007-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11010990) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2024-01-30 |