| NPI | 1467129049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021917) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95166305) | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2023-06-28 |