| NPI | 1659933075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 822801) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 822801) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0994746-NP) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0994746-NP) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-12-05 |