| NPI | 1962831354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991213-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013311) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2016-09-20 |