| NPI | 1699512756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.1001386-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO RN.1639791) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2026-04-20 |