| NPI | 1134861123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95020637) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11019279) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 852172) | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2023-06-02 |