| NPI | 1922649748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95035698) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95344829) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 95344829) | |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2025-12-24 |