| NPI | 1245866946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996943-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1621711) |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2022-07-28 |