| NPI | 1265564884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 508663) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 508663) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-06-16 |