| NPI | 1952063109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95016054) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 95016054) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2024-11-21 |