| NPI | 1861139628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: CA PA61412) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA61412) |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2025-08-29 |