NPI | 1952856502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95007305) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95070370) |
Enumeration Date | 2016-08-23 |
Last Update Date | 2024-10-15 |