| NPI | 1194722256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP1902) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ AP1902) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2008-08-25 |