| NPI | 1366167249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0998120-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN1661816) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2023-11-27 |