Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | PA.0005615 | CO |
NPI | 1639739097 |
---|---|
Provider Name | Bryan Clifford Handwork |
First Address | Boulder, CO 80303-1017 |
Second Address | Boulder, CO 80303-1017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 18/06/2019 |