| NPI | 1659919785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0995235-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 0995235) |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2021-11-30 |