| NPI | 1376268037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95025460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 833764) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-10-14 |