| NPI | 1962466094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0992250-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0992250-NP) |
| 111N00000X Chiropractor (Licence: CO 5373) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2024-05-20 |