NPI | 1245563543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028122) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 679231) |
Enumeration Date | 2009-09-17 |
Last Update Date | 2024-07-30 |