| NPI | 1245092295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0999568-NP) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CO APN.0999568-NP) |
| 163WC1500X Registered Nurse, Community Health (Licence: CO RN.1629263) | |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2025-12-02 |