| NPI | 1114342805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000474) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN 676426) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95000474) | |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2024-05-02 |