| NPI | 1265193080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95026056) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95026056) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2026-07-23 |