| NPI | 1154835197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0997339-NP) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: VA 00000000000) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: VA 000000000000) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: VA 000000000000) | |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2019-10-28 |