| NPI | 1841701422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95012918) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95094023) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012918) | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2021-11-29 |