NPI | 1346884301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014419) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CT 137266) |
Enumeration Date | 2019-11-03 |
Last Update Date | 2020-06-10 |