| NPI | 1720541170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0996481-NP) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CO RN.0199010) |
| 364S00000X Clinical Nurse Specialist (Licence: CO RXN.0103920-CNS) | |
| 363L00000X Nurse Practitioner (Licence: CO RXN.0105559-NP) | |
| 364S00000X Clinical Nurse Specialist (Licence: CO APN.0994548-CNS) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2021-05-04 |