NPI | 1912518572 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 276718) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 276718) |
Enumeration Date | 2020-08-16 |
Last Update Date | 2024-03-20 |