| NPI | 1083381842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 305310) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN203828) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2024-04-19 |