| NPI | 1629099320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0999794-NP) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN0003520-CRNA) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-06-05 |