| NPI | 1720642846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0994603-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 994603) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2025-07-15 |