| NPI | 1588933592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95004102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN795142) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2016-07-26 |