| NPI | 1376921940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0999860-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 0203070) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2026-02-26 |