| NPI | 1174936462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID NP-1535A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN158139) |
| 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1535A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 2011013620) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2021-03-04 |