NPI | 1316665664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95024206) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95029547) |
Enumeration Date | 2022-08-22 |
Last Update Date | 2023-02-27 |