| NPI | 1770143430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95034112) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 111054-23) |
| 163W00000X Registered Nurse (Licence: CA 95410984) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP021192) | |
| 163W00000X Registered Nurse (Licence: NH 111054-21) | |
| 163W00000X Registered Nurse (Licence: PA RN694705) | |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2025-10-29 |