| NPI | 1942730346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 615164) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NP95039502) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2026-09-15 |