| NPI | 1104248376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95018793) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 794147) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 794147) | |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2024-05-07 |