| NPI | 1871361477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO APN.0999678-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0101572-C-NP) |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2024-07-17 |