| NPI | 1669095253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995950-NP) |
| Additional Taxonomies | 163WU0100X Registered Nurse, Urology (Licence: CO 1633846) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-11-12 |