| NPI | 1205458049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 95278068) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 701887) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-07-26 |