| NPI | 1083002372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN-0991533-NP) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO APN.0991533-NP) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2025-03-13 |