| NPI | 1407499635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0004488-C-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 233539) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2024-02-05 |