| NPI | 1932898657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95396611) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1117621) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-12-22 |