| NPI | 1760749295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0990368-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 0178373) |
| Enumeration Date | 2012-04-22 |
| Last Update Date | 2017-12-05 |