NPI | 1225672900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021159) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95203116) |
Enumeration Date | 2019-11-05 |
Last Update Date | 2023-05-31 |