| NPI | 1861226052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.1000526-NP) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CO RN.1655045) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-01-30 |