| NPI | 1124294145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 17357) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA RN 614482) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-02-28 |