| NPI | 1316939630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ ap1112) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1112) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-04-02 |