| NPI | 1215253224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95005776) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163W00000X Registered Nurse (Licence: NY 757022-1) | |
| 163W00000X Registered Nurse (Licence: CA 95040852) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2023-07-19 |