NPI | 1285911214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 21303) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 21303) |
Enumeration Date | 2011-11-04 |
Last Update Date | 2023-08-17 |