| NPI | 1245709112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95008025) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008025) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2021-05-13 |