| NPI | 1326560871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0993173-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0993173-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993173-NP) | |
| Enumeration Date | 2017-07-16 |
| Last Update Date | 2026-08-13 |