| NPI | 1104417229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 666249) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 666249) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-08-25 |