| NPI | 1588336804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95025536) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN264082) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2023-07-06 |