| NPI | 1568074672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WY 46592) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0995788-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 46592) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2022-11-07 |