| NPI | 1275282022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 000000) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CO Q232461) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-10-07 |