| NPI | 1720213812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95019975) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 200181) |
| 363L00000X Nurse Practitioner (Licence: WI 9921-33) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9921-33) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11016687) | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2023-09-06 |