| NPI | 1811027204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 122180) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID NP-941) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-11-13 |