| NPI | 1477929461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95013538) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013538) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 697369) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2022-10-05 |