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Individual

THU TA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RDS

Contact information

Practice address
10065 E. HARVARD AVE, DENVER, CO 80231
(303) 743-5855
Mailing address
5515 REVERE ST, DENVER, CO 80239

Taxonomy

Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary

Other

Enumeration date
05/03/2007
Last updated
07/08/2007
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