NPI | 1376386623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031323) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95211730) |
Enumeration Date | 2024-06-14 |
Last Update Date | 2024-08-01 |