| NPI | 1164723987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 990051) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO 990051) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2019-07-26 |