| NPI | 1184350605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0998169-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1653807) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-12-09 |