| NPI | 1164814513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0992267-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1623445) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2022-11-02 |