| NPI | 1073158721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.1000603-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2319678) |
| Enumeration Date | 2019-11-16 |
| Last Update Date | 2025-03-04 |