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