| NPI | 1902327075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014981) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95100174) |
| 163WC0400X Registered Nurse, Case Management (Licence: CA 95100174) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA 4647) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-05-01 |