| NPI | 1093107732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95015577) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: CA 95015577) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN827983) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-05-08 |