NPI | 1912542861 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0103097-C-NP) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-175672) |
Enumeration Date | 2019-11-14 |
Last Update Date | 2025-03-03 |