| 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 |