| NPI | 1487368114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030942) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95120920) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 95120920) | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2024-09-26 |