| NPI | 1134880859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11017299) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0003820-C-NP) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2026-03-23 |