| NPI | 1285945964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 10181) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0010181-NP) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2019-05-20 |