| NPI | 1831969856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028564) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0998876-NP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95028564) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95028564) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0998876-NP) | |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-08-21 |