| NPI | 1730728841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 834379) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 834379) |
| 363L00000X Nurse Practitioner (Licence: CA 9514307) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 9514307) | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2024-08-18 |