| NPI | 1144030925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95038901) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 39796) |
| 163W00000X Registered Nurse (Licence: TN 281472) | |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2026-08-12 |