| NPI | 1629278304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 532792) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 532792) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN 532792) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2016-10-25 |