| NPI | 1992839120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002363) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 666762-1) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2015-07-21 |