| NPI | 1154898914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0994258-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0994258-NP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CO APN.0994258-NP) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-05-08 |