| NPI | 1346006384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0101962) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CO 1677442) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-03-07 |