| NPI | 1558607440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CA 95003401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 743486) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95003401) | |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2024-01-25 |