| NPI | 1295089332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95003600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 771286) |
| Enumeration Date | 2012-10-26 |
| Last Update Date | 2016-04-13 |