| NPI | 1538836028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN195764) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 302097) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-01-10 |