| NPI | 1437880721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014252) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95014252) |
| 163W00000X Registered Nurse (Licence: CA 95129842) | |
| 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: CA 554434) | |
| Enumeration Date | 2022-06-18 |
| Last Update Date | 2024-05-14 |