NPI | 1346929312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95025993) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-07-17 |
Last Update Date | 2025-10-06 |