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