| NPI | 1134699218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95010524) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: CA NP95010524) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP95010524) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95010524) | |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2024-05-03 |