| NPI | 1245899244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0994732-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1631408) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-06-25 |