| NPI | 1578583209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP5146) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: AZ 88395) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-04-26 |