| NPI | 1659001667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 090872-23) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: CO APN.0997480-NP) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN.0997480-NP) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-01-11 |