| NPI | 1841378247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 16637) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP4292) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP4293) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2026-04-28 |