| NPI | 1619132297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95036754) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2025-09-29 |