| NPI | 1871219204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95019846) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95019846) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2024-07-09 |