| NPI | 1255460952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021678) |
| Additional Taxonomies | 101Y00000X Counselor |
| 363L00000X Nurse Practitioner (Licence: CA 95021678) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2025-06-27 |