| NPI | 1497792543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO 1906) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 70254) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-06-04 |