| NPI | 1528837135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028581) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 106S00000X Behavior Technician | |
| 163W00000X Registered Nurse (Licence: OH 462845) | |
| 163W00000X Registered Nurse (Licence: CA 806548) | |
| 163WC1500X Registered Nurse, Community Health (Licence: CA 552455) | |
| 283Q00000X Psychiatric Hospital | |
| Enumeration Date | 2023-12-22 |
| Last Update Date | 2025-04-17 |