| NPI | 1760253231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95199324) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2026-04-23 |