| NPI | 1881946978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP11719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN171784) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2018-10-04 |