| NPI | 1437665528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN.0993486-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP135593) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0993486-NP) | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2022-01-25 |