NPI | 1669822391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021215) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95060012) |
Enumeration Date | 2016-06-14 |
Last Update Date | 2024-02-15 |