| NPI | 1821441551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95134782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 709540) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5010017) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2021-10-28 |