NPI | 1215686167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95020693) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95144162) |
Enumeration Date | 2022-03-19 |
Last Update Date | 2022-07-22 |