| NPI | 1336686609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0992897) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN0992897) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2020-02-06 |