| NPI | 1760003040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C-APN-0101914-C-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP145939) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP145939) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2024-06-28 |