| NPI | 1467192799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997470-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO RXN.0106491-NP) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2022-04-04 |