| NPI | 1023072519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP3376) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3313) |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: AZ AP3314) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2018-08-10 |