| NPI | 1548256142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP1598) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AZ RN103936) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP1598) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2021-04-28 |