| NPI | 1669989752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95021750) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95228740) |
| 172V00000X Community Health Worker | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95021750) | |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2023-07-26 |