| NPI | 1467054445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95039291) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 95206438) |
| 163WC0400X Registered Nurse, Case Management (Licence: CA 95206438) | |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2026-08-29 |