| NPI | 1326595125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95004317) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NV 836179) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NV 836179) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2023-08-21 |