| NPI | 1245993229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95188653) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN95188653) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2025-09-10 |