NPI | 1134605447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95372701) |
Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN687230) |
Enumeration Date | 2018-07-19 |
Last Update Date | 2024-03-27 |