| NPI | 1669159059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0998801-NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO RN.1666695) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2025-10-29 |