| NPI | 1649164112 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1000960) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1676087) |
| Enumeration Date | 2025-06-07 |
| Last Update Date | 2025-08-19 |