| NPI | 1477021764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012975) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 61527591) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 294766) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9376910) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 9376910) | |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2025-11-14 |