| NPI | 1215396494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NPF95015453) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 837552) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2021-07-10 |