| NPI | 1902296759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0991821-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0991821-NP) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2018-10-16 |