NPI | 1447652409 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 991309) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704274155) |
163W00000X Registered Nurse (Licence: CO 1627153) | |
Enumeration Date | 2014-09-22 |
Last Update Date | 2021-02-11 |