| NPI | 1609383082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95017742) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 23860) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23860) | |
| Enumeration Date | 2018-01-06 |
| Last Update Date | 2025-11-05 |