| NPI | 1518756725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95037719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 281471) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2026-04-03 |