| NPI | 1972131761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA PA58801) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA58801) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2025-12-02 |