| NPI | 1447816491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022117) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 742150) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402659) | |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2023-04-05 |