| NPI | 1861023137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 0995355) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1636065) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2026-02-06 |