| NPI | 1043622624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 820592) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 950252) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2023-12-13 |