| NPI | 1083095111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95015157) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95022472) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 95022472) | |
| 163WC0400X Registered Nurse, Case Management (Licence: CA 95022472) | |
| 163WR0400X Registered Nurse, Rehabilitation (Licence: CA 95022472) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-09-13 |