| NPI | 1134726391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0996057-NP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CO T-APN.0000022) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2021-07-30 |