| NPI | 1235714189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 261161) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN207780) |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2025-04-22 |