| NPI | 1194119024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95029194) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 836478) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0104762-C-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G185565) | |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2025-09-17 |