| NPI | 1104434935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: CO APN.0995710-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CO APN.0995710-NP) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CO APN.0995710-NP) | |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-17 |