| NPI | 1326614934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C-APN.0102149-C-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-154160) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11013519) | |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2024-04-15 |