NPI | 1639718133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95021450) |
Additional Taxonomies | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: CA 95078539) |
Enumeration Date | 2019-12-31 |
Last Update Date | 2022-06-27 |