| NPI | 1962870907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002211) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95002211) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-05-09 |