| NPI | 1265556617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 15823) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 15823) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2018-11-20 |