| NPI | 1881241131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0994905-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 091111) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2024-01-24 |