| NPI | 1316581812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95019043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95039192) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2021-11-18 |