| NPI | 1407878564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR A03502ANP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AR 49985) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-10-10 |