| NPI | 1982214136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0995529-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0995529-NP) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2022-04-12 |