| NPI | 1225868623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031206) |
| Additional Taxonomies | 2083B0002X Preventive Medicine, Obesity Medicine (Licence: CA 95031206) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA NP95031206) | |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-06-03 |