| NPI | 1609094945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012580) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 32927) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2019-08-30 |