| NPI | 1003047325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1087481) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: CO 165719) |
| 163WE0003X Registered Nurse Emergency (Licence: TX 651431) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: CO APN.0010074-NP) | |
| 363LF0000X Nurse Practitioner Family (Licence: CO NP 10074) | |
| 363LF0000X Nurse Practitioner Family (Licence: CO APN.0010074-NP) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2025-07-31 |