| NPI | 1639478514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95002151) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 766862) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95002151) | |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2024-05-31 |