| NPI | 1033432042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP5340) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401383) |
| 163W00000X Registered Nurse (Licence: AZ RN182737) | |
| 163W00000X Registered Nurse (Licence: NY 22 602744) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2023-10-11 |