| NPI | 1780784488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN5637) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI DEA-MC0345466) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA DEA-MC1624041) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP16861) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI CSR-RN2050) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2026-03-20 |