| NPI | 1609572783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0998412-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 0998412) |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2024-06-14 |