| NPI | 1528813219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RNP315668) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AZ RN172749) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-11-11 |