| NPI | 1649577925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95003902) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 163W00000X Registered Nurse (Licence: CA 847545) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2022-07-21 |