NPI | 1205323607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95012928) |
Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 95140460) |
363L00000X Nurse Practitioner (Licence: CA 95012928) | |
Enumeration Date | 2018-04-20 |
Last Update Date | 2020-10-12 |