| NPI | 1710367453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN204465) |
| 163W00000X Registered Nurse (Licence: FL RN9358059) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9358059) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2018-05-24 |