| NPI | 1720716707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AR 221606) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012033480) |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2022-08-15 |