NPI | 1528823689 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA PA65341) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA65341) |
Enumeration Date | 2024-02-19 |
Last Update Date | 2025-08-28 |