NPI | 1124897046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95166131) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031637) |
Enumeration Date | 2023-12-20 |
Last Update Date | 2024-08-12 |