| NPI | 1467738963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95015637) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 771398) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2021-09-17 |