| NPI | 1508956186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CO APN.0004860-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO NP4860) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-10-17 |