| NPI | 1225398795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0992753-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 32853.1280) |
| 163W00000X Registered Nurse (Licence: CO 170662) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2018-05-25 |