| NPI | 1386038891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0991546-NP) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CO APN.0991546-NP) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2020-07-24 |