| NPI | 1790183416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997946-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0003532-C-APN) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP08146) | |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2023-05-24 |