| NPI | 1609331560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010473) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95010473) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 79465) | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2025-12-30 |