| NPI | 1487128989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CO APN.0994179-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 994179) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-04-25 |