NPI | 1033788971 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0996571-NP) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO F05210641) |
Enumeration Date | 2021-06-24 |
Last Update Date | 2023-12-29 |