| NPI | 1336816313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 1014613) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1180039) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1180039) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021801) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95021801) | |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2026-03-24 |