| NPI | 1780619783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G80502) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G80502) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95004106) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95004106) | |
| 208D00000X General Practice (Licence: CA G80502) | |
| 163WG0000X Registered Nurse, General Practice (Licence: CA 780292) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CA G80502) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-04-28 |