| NPI | 1124639943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA NONE) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 1124639943) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2023-04-17 |