| NPI | 1033424494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95039945) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA vn227366) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2026-06-11 |