| NPI | 1407494735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA NP95013014) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95013014) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2020-02-13 |