| NPI | 1073157491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028965) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95355854) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 704361) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402811-01) | |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2025-05-12 |