| NPI | 1689321580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028903) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95210829) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95210829) | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2025-03-25 |