| NPI | 1245998459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO C-APN.0003547-C-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 248388) |
| Enumeration Date | 2021-12-04 |
| Last Update Date | 2022-02-28 |