| NPI | 1558606467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP4991) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 5134-033) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP8953) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2024-08-08 |