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 |