| NPI | 1386663649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 187081) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 56575534408) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-04-05 |