| NPI | 1013698232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95034156) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 78261) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2025-04-09 |