| NPI | 1144530817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95010108) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0202901) |
| 163W00000X Registered Nurse (Licence: CO RXN.0100320-NP) | |
| 363L00000X Nurse Practitioner (Licence: CO APN.0990294-NP) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5004909) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2022-03-10 |