| NPI | 1871242669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95025356) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95182846) |
| 363L00000X Nurse Practitioner (Licence: CA 95025356) | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2026-01-13 |