| NPI | 1598916090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95034576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 730858) |
| 164X00000X Licensed Vocational Nurse (Licence: CA VN195083) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2026-04-17 |