| NPI | 1922483858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0992363-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0993263-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9310885) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2022-12-20 |