| NPI | 1144693532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN.0995050-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NH 072618-21) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2021-11-17 |