| NPI | 1396306270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95103397) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-149892) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R240364) | |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2023-12-21 |