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