| NPI | 1063778470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: CA RN452408) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN452408) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |