| NPI | 1194896753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0003114-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 86563) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2015-10-14 |