| NPI | 1457172926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95038668) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN95347754) |
| 163W00000X Registered Nurse (Licence: CA RN95347754) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA RN95347754) | |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2026-02-24 |