| NPI | 1912556770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0995756-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1669715) |
| 363L00000X Nurse Practitioner (Licence: KS 79201) | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2020-08-07 |