| NPI | 1891925285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0990854-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 187296) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO 990854) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2021-07-19 |