| NPI | 1407490824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 950285323) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95191113) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2024-05-07 |