| NPI | 1801486766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95023906) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 839510) |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2024-05-14 |