| NPI | 1861734428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 21812) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 16777) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 21812) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2014-07-30 |