| NPI | 1063695013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0990909-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 3259) |
| 363LF0000X Nurse Practitioner, Family (Licence: DE LB-0000216) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2014-02-05 |