| NPI | 1659984979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0999052-NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO RN.0197852) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 2020044081) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-05-13 |