| NPI | 1639545312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996831-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1643589) |
| 163W00000X Registered Nurse (Licence: NE 80359) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2023-04-19 |