| NPI | 1205976941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022963) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN95235553) |
| 1041C0700X Social Worker, Clinical (Licence: CA 79451) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2024-09-30 |