| NPI | 1124447974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 23227) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 489109) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2016-11-30 |