| NPI | 1699471706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0998356-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN0998356-NP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CO APN.0998356-NP) | |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2023-11-10 |