| NPI | 1760085112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0995882-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0995882-NP) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2022-02-23 |