| NPI | 1184669806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 65648) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 991803-NP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA 254580) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-01-03 |