| NPI | 1669032876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C-APN.0004430-C-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9024277-3102) |
| 174400000X Specialist (Licence: CO C-APN.0004430-C-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 9024277-4405) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-10-11 |