| NPI | 1710414875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95027238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 844492) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2024-02-20 |