| NPI | 1255153706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95038362) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95038362) |
| Enumeration Date | 2024-10-28 |
| Last Update Date | 2026-07-06 |