| NPI | 1366923666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN.0994073-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0122348) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2023-07-18 |