| NPI | 1669967220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP11703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN176137) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2019-08-26 |