| NPI | 1417569138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RNP268522) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: AZ RN217054) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2022-03-16 |