| NPI | 1023990165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95344774) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95037447) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-10-31 |