NPI | 1750146031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031785) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95199589) |
Enumeration Date | 2024-02-16 |
Last Update Date | 2024-10-02 |