| NPI | 1497899702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C.APN.000269-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2004023277) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2021-09-07 |