| NPI | 1013642669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021343) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 762942) |
| 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: CA 552127) | |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2026-04-28 |