| NPI | 1831605658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AZ AP10690) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP10690) |
| 363LF0000X Nurse Practitioner Family (Licence: MA RN2257932) | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2021-10-27 |