| NPI | 1629935325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R243956) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95307867) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95039060) | |
| Enumeration Date | 2026-01-06 |
| Last Update Date | 2026-05-12 |