| NPI | 1003293606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP7776) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ AP7776) |
| Enumeration Date | 2015-05-03 |
| Last Update Date | 2025-08-21 |