| NPI | 1649637463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO APN APN.0992361-NP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN0992361) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2026-01-12 |