| NPI | 1902278708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0992334-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WY 35609.1457) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2019-09-09 |