| NPI | 1790408946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022516) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 95053159) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-22 |