| NPI | 1598565483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95034143) |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-07-31 |