| NPI | 1861882847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95017534) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28278) |
| 101YP2500X Counselor, Professional (Licence: AR P1701203) | |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2024-02-02 |