| NPI | 1225807597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN95334394) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95036538) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2025-12-02 |