NPI | 1235829201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 291618) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN181884) |
Enumeration Date | 2023-05-11 |
Last Update Date | 2024-10-09 |