| NPI | 1396237202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F405279) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN1622198) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO RN1622198) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-10-31 |