| NPI | 1578344313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1001817-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1625791) |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2026-04-03 |