NPI | 1245705235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT MED-APRN-LIC-158319) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0994176) |
Enumeration Date | 2018-10-05 |
Last Update Date | 2023-08-17 |