| NPI | 1346858404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0998159-NP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0998159-NP) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-12-29 |