| NPI | 1083887962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0004547-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0004547-NP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CO RN.0122229) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CO RXN.0100271-NP) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2024-06-04 |