| NPI | 1154868420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95008494) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95022888) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2023-02-21 |