| NPI | 1669526752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 16458) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 481568) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 16458) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2025-04-29 |