| NPI | 1275238560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95037698) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95244841) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-01-02 |