NPI | 1881232429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA PA58434) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2019-12-13 |
Last Update Date | 2025-08-29 |