| NPI | 1881153146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO C-APN.0003606-C-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-166190) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2022-02-21 |