| NPI | 1255667440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 61768) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3061) |
| 163W00000X Registered Nurse (Licence: CO 168340) | |
| 363L00000X Nurse Practitioner (Licence: CO 10141) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2022-01-04 |