| NPI | 1114420429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 269313) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 918855) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2022-01-26 |