| NPI | 1306662267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA PA65960) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA65960) |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2026-05-21 |