| NPI | 1619384864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001026) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 722310) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-08-01 |