| NPI | 1528655651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 0996078) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: CO 164932) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO 0996078-NP) | |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2022-04-19 |