| NPI | 1720846058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 305418) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA g178551) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 36162) | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-06-10 |