| NPI | 1245085240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 305830) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ 305830) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OH 464615) | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-08-30 |