| NPI | 1578290748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA 1922516962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 867030) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2022-08-06 |
| Last Update Date | 2025-09-22 |