NPI | 1003107616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95005123) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 743245) |
Enumeration Date | 2011-04-29 |
Last Update Date | 2018-06-20 |