| NPI | 1114088564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP5187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA RN130405-AP06200) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM RN-74995 CNP-01955) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RN183116) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2015-06-30 |