| NPI | 1598510596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1400X Registered Nurse, College Health (Licence: CA RN95265374) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA RN95265374) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2026-06-15 |