| NPI | 1871368480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95027115) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95027115) |
| Enumeration Date | 2023-11-24 |
| Last Update Date | 2024-02-13 |