| NPI | 1508440439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95016142) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX 1016767) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1016767) | |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2025-04-23 |