| NPI | 1891110342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9315515) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95370739) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9315515) | |
| 363A00000X Physician Assistant (Licence: CA 95370739) | |
| 363AM0700X Physician Assistant, Medical (Licence: CA 95370739) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95370739) | |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2025-11-21 |