| NPI | 1720605207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 249331) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN201614) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2026-05-20 |