| NPI | 1437573508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 86602) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C.rxn.0100341-c-np) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-apn.0100511-c-np) | |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2024-08-22 |