| NPI | 1750152344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030284) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: CA 631790) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2025-01-20 |