| NPI | 1669042347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996974-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1645444) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-09-28 |