| NPI | 1093325409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 200327) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 904119) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0002218-C-NP) | |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2021-03-10 |