| NPI | 1720597628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: SC 24334) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: KS APN.79610) |
| 208M00000X Hospitalist (Licence: CO APN.0993436-NP) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CO APN.0993436-NP) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2021-07-12 |