| NPI | 1629575345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0103879) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NE 112453) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 37741.1750) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO 0993371-NP) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-01-15 |