| NPI | 1255819611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995190-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0995190-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 53393) | |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2023-10-04 |