| NPI | 1700340114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0001863-C-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11001158) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 112782) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2020-09-23 |