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 |