| NPI | 1922362201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0990417-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 184839) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO NP990417) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2024-01-16 |