| NPI | 1548600901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO 0990643) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP-02213) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2016-10-06 |