| NPI | 1235464447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 19354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 3269) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2016-11-29 |