| NPI | 1407157159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0992274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 204964) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0992274) | |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2023-02-24 |