| NPI | 1366908543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95019677) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95181593) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2024-05-18 |