| NPI | 1104984020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 786001) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 24970) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-09-28 |