| NPI | 1578877445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 19979) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 19979) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11038660) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11038660) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2026-08-21 |