NPI | 1497284202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95017723) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95079457) |
Enumeration Date | 2017-06-06 |
Last Update Date | 2021-09-06 |