| NPI | 1891536041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030778) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 713755) |
| 363L00000X Nurse Practitioner (Licence: CA NP95030778) | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-10-19 |