| NPI | 1679123806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95021552) |
| Additional Taxonomies | 101Y00000X Counselor |
| 163W00000X Registered Nurse (Licence: FL 9370733) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2023-11-02 |