| NPI | 1073937819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0993172-NP) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO APN.0993172-NP) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 6686225-8900) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 6686225-4405) | |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2019-07-26 |