| NPI | 1407581432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0997796-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0997796) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-12-15 |