| NPI | 1316516065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 299547) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2018008495) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95026658) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2024-03-27 |