NPI | 1649628322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95007019) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 779746) |
Enumeration Date | 2016-06-02 |
Last Update Date | 2022-08-05 |