| NPI | 1932450954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95000350) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 806846) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95000350) | |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2014-04-22 |