| NPI | 1235523150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 834977) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002468) | |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2022-07-20 |