NPI | 1770753618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022661) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
163W00000X Registered Nurse (Licence: CA 95118903) | |
Enumeration Date | 2008-03-06 |
Last Update Date | 2024-02-19 |