| NPI | 1083103956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95008823) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95008823) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP95008823) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-06-25 |