| NPI | 1790637866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95039550) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95298784) |
| Enumeration Date | 2026-02-11 |
| Last Update Date | 2026-05-15 |