| NPI | 1396295374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993604-NP) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CO RN0178128) |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2021-12-02 |