NPI | 1679203244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95025925) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95258133) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95025925) | |
Enumeration Date | 2022-06-15 |
Last Update Date | 2023-10-20 |