NPI | 1184370934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028269) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95140971) |
Enumeration Date | 2022-03-01 |
Last Update Date | 2024-06-12 |