| NPI | 1457641979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 876341) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 35648) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2024-06-07 |