| NPI | 1083346712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0997818-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 1623584) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2022-08-17 |