| NPI | 1396382206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95013959) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11017450) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95013959) | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2026-01-20 |