| NPI | 1124471628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95003841) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95003841) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201601589NP-PP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201501589NP-PP) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2025-03-20 |