| NPI | 1679833016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 76856) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001375) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP7767) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2023-05-16 |