| NPI | 1881858868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001898) |
| Additional Taxonomies | 101Y00000X Counselor |
| 163W00000X Registered Nurse (Licence: NY 658352-1) | |
| 163W00000X Registered Nurse (Licence: CA 95035248) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2025-04-17 |