| NPI | 1073952057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9238390) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO C-APN.0001795-C-NP) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2023-09-28 |