| NPI | 1871136929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95013061) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: CA 95013061) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2024-01-04 |