| NPI | 1326693326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95026966) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN95171379) |
| 163W00000X Registered Nurse (Licence: NC 283910) | |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-03-22 |