| NPI | 1528252566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0995048-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP115652) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP115652) | |
| 163W00000X Registered Nurse (Licence: CO Rn.1661093) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0995048-NP) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2025-09-05 |