| NPI | 1477601805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0004626-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APN001175) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO 129867) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 18479) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3528) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-06-08 |