| NPI | 1992086839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 0991049) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 0991049) |
| 363L00000X Nurse Practitioner (Licence: KS 75474) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 77748) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 77748) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2024-03-29 |