| NPI | 1417615345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0999039-np) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO c-apn.0003548-c-np) |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2024-01-09 |