| NPI | 1295064665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0994999-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1664145) |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2022-10-12 |