| NPI | 1700541042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 65684) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN169587) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA 163WP0808X) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2309461) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 263686) | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2023-05-15 |