| NPI | 1245827674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.1000756-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1630524) |
| 225500000X Specialist/Technologist (Licence: CO 07-07024) | |
| 225700000X Massage Therapist (Licence: CO 0022025) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CO APN.1000756-NP) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2025-05-17 |