| NPI | 1508457003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0997785-NP) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 1655477) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 1655477) | |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2022-09-09 |