| NPI | 1639917842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95040585) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 95023840) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 408625) | |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2026-07-14 |