| NPI | 1013403914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0993973) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO 1654911) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 695455-1) | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2025-04-23 |