NPI | 1649278318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN0002658) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 109020) |
Enumeration Date | 2005-07-07 |
Last Update Date | 2016-02-04 |