| NPI | 1760993109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: CO APN.0994461-NP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: KY 3011798) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: OH APRN.CNP.022386) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: KY 3011798) | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2019-04-05 |