| 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 |