| NPI | 1922465830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP10145) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP10145) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024173162) | |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2021-03-26 |