| NPI | 1730957903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0999501) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 1679432) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-09-06 |