| NPI | 1942605126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001041) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95001041) | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2023-12-01 |