| NPI | 1265188775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0997383-NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO 1651139) |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2022-02-28 |