| NPI | 1366248742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95036319) |
| Additional Taxonomies | 163WG0100X Registered Nurse, Gastroenterology (Licence: CA 95137539) |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-08-06 |