NPI | 1255761110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0990977-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1623805) |
Enumeration Date | 2013-11-13 |
Last Update Date | 2024-03-07 |