| NPI | 1003635582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1000221-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO RXN.0109235-NP) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |