| NPI | 1003424771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 276789) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN206350) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2022-06-23 |