| NPI | 1033050760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO 1664388) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1002219-NP) |
| Enumeration Date | 2026-04-06 |
| Last Update Date | 2026-08-06 |