| NPI | 1811595473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0995622-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO RXN.0104805-NP) |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2021-01-14 |