| NPI | 1902297708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0992042-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200941876RN) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201408562NP-PP) | |
| 163W00000X Registered Nurse (Licence: CO RN.1632098) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2018-01-23 |