| NPI | 1023581303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95178303) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2022-06-30 |