| NPI | 1255854246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP10503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10503) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-01-03 |