| NPI | 1912613241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0998398-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0998398-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0998398-NP) | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2025-12-23 |