| NPI | 1144815754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95035349) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95116951) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2025-10-27 |