| NPI | 1114458718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995680) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN-1628386) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2021-04-22 |