| NPI | 1083054803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95000954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 806399) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2015-05-11 |