| NPI | 1356957021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 187253) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO RXN.0105411-NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0996320-NP) | |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2023-01-11 |