| NPI | 1225016447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 538726) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP 13343) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2018-08-29 |