| NPI | 1285170167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0992922-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1617564) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2017-02-13 |