| NPI | 1033561444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95004514) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-176318) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 303860) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT Nur-APRN-LIC-176318) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 303860) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95004514) | |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2026-07-28 |