| NPI | 1447765409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014417) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95043929) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R244114) | |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2022-09-16 |