| NPI | 1174920631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN0991545-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN1618208) |
| 363LF0000X Nurse Practitioner Family (Licence: CO APN0991545-NP) | |
| Enumeration Date | 2014-11-28 |
| Last Update Date | 2019-09-04 |