| NPI | 1124518725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0993764-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: DC 1048551) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2021-10-13 |