| 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 |