NPI | 1235645391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95008262) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008262) |
Enumeration Date | 2017-12-27 |
Last Update Date | 2024-04-23 |