| NPI | 1639413016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95028036) |
| Additional Taxonomies | 101Y00000X Counselor |
| 163W00000X Registered Nurse (Licence: CA 95238060) | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2023-12-22 |