| NPI | 1366604506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO C-APN.0000199-C-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP01482) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NM R67367) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304819) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2020-06-24 |