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 |