| NPI | 1841857968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95296790) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 163W00000X Registered Nurse (Licence: CA 95296790) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2023-11-14 |