| NPI | 1801236625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002713) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 670490) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95002713) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-07-05 |