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 |