NPI | 1609654755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA PA63360) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA63360) |
Enumeration Date | 2023-09-19 |
Last Update Date | 2025-08-29 |