| NPI | 1053937599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 248871) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ RN168108) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 248871) | |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2024-07-23 |