| NPI | 1578179503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 0995952) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO Pending) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2022-11-29 |