| NPI | 1700288958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WY 35871.1415) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NE 112740) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN 0991413-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN0991413-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 35871.1415) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2019-03-25 |