| NPI | 1124295332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN279645) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: CA 581186) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 17645) | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: CA 2794) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2022-03-30 |