| NPI | 1891861324 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95016741) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 499219) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 499219) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2021-11-01 |