| NPI | 1205450202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0995551-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1621533) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-04-07 |