| NPI | 1720738966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95021573) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60969109) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95021573) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-07-07 |