| NPI | 1861072233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 11097773-4405) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: UT 11097773-4405) |
| 363LF0000X Nurse Practitioner Family (Licence: UT 11097773-4405) | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2024-07-01 |