| NPI | 1487958070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0990467-NP) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: CO ANP0990467) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2023-10-05 |