| NPI | 1710435524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95034960) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 832363) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2025-12-23 |