| NPI | 1659165017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 57166) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CO RN.1639037) |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-10-16 |