| NPI | 1245667351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 23599) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 23599) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2025-03-19 |