| NPI | 1700359536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0994212-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1634524) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2025-10-29 |