| NPI | 1861564312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 621643) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 15914) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CA 2311) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |