| NPI | 1144686577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 2020011541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 835101) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95003723) | |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2024-11-04 |