| NPI | 1770283921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 286130) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1112295) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 73419) | |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-01-10 |