| NPI | 1205344066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014718) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 241043) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 821264) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 7407) | |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2023-09-28 |