| NPI | 1275845935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP8266) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3724) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2022-08-08 |