| NPI | 1437135159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 3808) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: CA 28980) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 546) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 3808) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2022-12-14 |