| NPI | 1235086067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.1001743-NP) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO APN.1001743-NP) |
| Enumeration Date | 2026-03-11 |
| Last Update Date | 2026-05-13 |