| NPI | 1134952625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031692) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14207560-4405) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 350578) | |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2025-03-17 |