| NPI | 1386175107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0996145-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1643895) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-01-05 |