| NPI | 1770753618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/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 |