| NPI | 1508231721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0995501-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN60626622) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60975342) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2021-07-01 |