| NPI | 1548727068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO APN.0999882-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1637748) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WY 55105) | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2024-08-08 |