| NPI | 1508627290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.1000561-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1625429) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2025-03-03 |