| NPI | 1932420379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9909) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2010019097) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-09-29 |