| NPI | 1467994244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95005292) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 95005292) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2018-03-17 |