| NPI | 1144606963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022706) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95026924) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 9502706) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2023-04-04 |