| NPI | 1114516150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95026593) |
| Additional Taxonomies | 163WM0102X Registered Nurse, Maternal Newborn (Licence: CA 95163409) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2025-10-06 |