| NPI | 1417692880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0100521-C-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 26051) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2023-08-10 |