| NPI | 1144589086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP4913) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201250163NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 707607) | |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2024-07-12 |