| NPI | 1013311216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0994550-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP126647) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO C-APN.0000882-C-NP) | |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2019-03-14 |