| NPI | 1720483050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.00991470-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991470-NP) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2018-11-07 |