| NPI | 1912184490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 5133) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 92404) |
| 364S00000X Clinical Nurse Specialist (Licence: CO 2580) | |
| Enumeration Date | 2008-01-27 |
| Last Update Date | 2010-11-15 |