| NPI | 1285811026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 355928) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 355928) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 355928) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2008-01-23 |