| NPI | 1093293623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 57234) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08236) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2021-12-13 |