| NPI | 1922710888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030982) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95301833) |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2025-01-16 |