| NPI | 1841368230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP5698) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: CA 367611) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-11-18 |