| NPI | 1023620473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ CNP285410) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RNP285410) |
| 163W00000X Registered Nurse (Licence: AZ RN210286) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2025-12-14 |