NPI | 1093310997 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95029453) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95181620) |
Enumeration Date | 2020-12-01 |
Last Update Date | 2024-03-14 |