| NPI | 1033675004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO 0995336-NP) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CO RN.0169891) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2023-06-28 |