| NPI | 1902528706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95240228) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-09-01 |