| NPI | 1801830963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 12761) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA pa12761) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-03-17 |