| NPI | 1790901668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-4861) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95329837) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-10-30 |