| NPI | 1689634008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CO 130034) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 130034) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-11-20 |