| NPI | 1982746749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 15951) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY19802) |
| 163W00000X Registered Nurse (Licence: CA 606401) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 15951) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-06-13 |