| NPI | 1346496767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 22192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 695830) |
| 163WC1500X Registered Nurse, Community Health (Licence: CA 73737) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2014-07-21 |