| NPI | 1003677816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95032055) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 274389) |
| 163W00000X Registered Nurse (Licence: CA 95386789) | |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-09-09 |