NPI | 1518366822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0995165-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1627572) |
Enumeration Date | 2014-08-22 |
Last Update Date | 2019-11-13 |