| NPI | 1851621171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0010054-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO NP-10054) |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2024-03-25 |