| NPI | 1558778043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95023069) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI aprn-4066) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2025-08-05 |