| NPI | 1518116839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN-0005603-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 721155) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 5603) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2022-07-26 |