| NPI | 1619313103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 3640) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 688299) |
| 363L00000X Nurse Practitioner (Licence: WI 6372) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 23675) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WI 6372) | |
| Enumeration Date | 2013-05-11 |
| Last Update Date | 2020-09-23 |