| NPI | 1013378967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 693049) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002238) |
| 163W00000X Registered Nurse (Licence: CA 693049) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2017-09-07 |