| NPI | 1164067922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP-263878) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN205161) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ None) | |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2023-12-08 |