| NPI | 1669086641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95024208) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP028851) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61096819) | |
| Enumeration Date | 2020-09-07 |
| Last Update Date | 2024-10-16 |