| 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 |