| NPI | 1083082283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 330534-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0175720) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991951-NP) | |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2021-08-31 |