| NPI | 1558034991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 0996238-NP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO 0996238-NP) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CO 0996238-NP) | |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2021-07-30 |