| NPI | 1639703572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0999691-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1664518) |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2020-03-01 |
| Last Update Date | 2026-02-06 |