Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0006267 | CO |
NPI | 1588017578 |
---|---|
Provider Name | Michael Rosen-Pyros |
First Address | Pueblo, CO 81004-1870 |
Second Address | Pueblo, CO 81004-1870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 15/07/2016 |