| NPI | 1205926888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0003581-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 97793) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-10-20 |