| NPI | 1124294145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 17357) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 17357) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2026-10-08 |