| NPI | 1710903281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9995) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN206577) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9999) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 8879) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 8879) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-05-20 |