| NPI | 1528252566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995048-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 656957) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0000512-C-NP) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 656957) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 656957) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2021-04-07 |