| NPI | 1851398184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO NP-4497) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO RN-122345) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO RXP-5094) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO NP-4434) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CO 5094) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CO RN-122345) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2021-06-11 |