NPI | 1679629513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0990535-NP) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 140944) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO RXN.0100732-NP) | |
Enumeration Date | 2007-01-25 |
Last Update Date | 2023-07-08 |