| NPI | 1548537400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0993969) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CO 190200) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993969-NP) | |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2025-07-09 |