| NPI | 1386636439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 86336) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CO 86336) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2013-12-10 |