NPI | 1407490824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 950285323) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95191113) |
Enumeration Date | 2019-10-29 |
Last Update Date | 2024-05-07 |