| NPI | 1487415113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO RN.1683337) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1000279-NP) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2025-01-10 |