| NPI | 1467803379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0992862-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1644158) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO RXN.0102485-NP) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-03-31 |