| NPI | 1851760557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0991962-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0191934) |
| 363L00000X Nurse Practitioner (Licence: CO APN.0991962-NP) | |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2021-09-09 |