| NPI | 1114199304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014582) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CT 081141) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 003960) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2023-01-24 |