| NPI | 1518331099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 305821) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1144227) |
| 163W00000X Registered Nurse (Licence: NY 706746) | |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2025-01-04 |