| NPI | 1093018137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0995119-NP) |
| Additional Taxonomies | 101Y00000X Counselor |
| 363L00000X Nurse Practitioner (Licence: MA RN2313972) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2018012688) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2024-06-25 |