| NPI | 1184221939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 255710) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN184275) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2024-04-11 |