| NPI | 1184393654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997172-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN1631454) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO RXN.0106234-NP) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2022-03-07 |