| NPI | 1033949136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO C-APN.0102463-C-NP) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: CO C-APN.0102463-C-NP) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |