| NPI | 1174003909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP11710) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ AP11710) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2022-02-17 |