| NPI | 1164277885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 227711) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: AZ 227711) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2025-06-02 |