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 |