| NPI | 1982186144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.01022117-C-NP) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60872393) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2026-03-27 |