NPI | 1942605126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001041) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95001041) |
163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95001041) | |
Enumeration Date | 2014-10-29 |
Last Update Date | 2023-12-01 |