| NPI | 1497391643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0995144-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN.0995144-NP) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2022-02-09 |