| NPI | 1134855331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO apn.0997787-np) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0997787-NP) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-09-14 |