| NPI | 1912611625 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95133038) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2024-09-26 |