NPI | 1184309684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 95025682) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95025682) |
Enumeration Date | 2023-06-21 |
Last Update Date | 2025-08-21 |