| NPI | 1831683465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ ap11413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ AP11413) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2020-12-07 |