NPI | 1669526752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 16458) |
Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 481568) |
363LF0000X Nurse Practitioner, Family (Licence: CA 16458) | |
Enumeration Date | 2007-01-23 |
Last Update Date | 2025-04-29 |