| NPI | 1386807030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014269) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 808252) |
| 164X00000X Licensed Vocational Nurse (Licence: CA 231037) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2021-10-12 |