| NPI | 1629353537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993296-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 186578) |
| 163W00000X Registered Nurse (Licence: MI 4704253266) | |
| 163W00000X Registered Nurse (Licence: MI 736242) | |
| 163W00000X Registered Nurse (Licence: CO RN.0186578) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704253266) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2018-03-17 |