| NPI | 1003149162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028051) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS25250) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2024-02-03 |