| NPI | 1861956054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 218603) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 218603) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 218603) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2026-01-28 |