| NPI | 1295351757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95024881) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404299) |
| 163W00000X Registered Nurse (Licence: CA 95325357) | |
| 163W00000X Registered Nurse (Licence: NY 794010) | |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2023-08-30 |