| NPI | 1063425429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2459247) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA RN 505988 NP11030) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA RN 505988 NP11030) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2022-07-21 |