NPI | 1053088799 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95017647) |
Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 849520) |
Enumeration Date | 2021-08-29 |
Last Update Date | 2024-05-21 |