| NPI | 1194215673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 256918) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN263120) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-07-19 |