| NPI | 1194952218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 20405) |
| Additional Taxonomies | 163WA2000X Registered Nurse Administrator (Licence: CA 715183) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: CA 715183) | |
| 363L00000X Nurse Practitioner (Licence: CA 20405) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: CA 20405) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 20405) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CA 20405) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2024-09-01 |