| NPI | 1629308135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95008495) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 851513) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0995819-NP) | |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2025-01-02 |