| NPI | 1225536782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95078548) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 29504) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2019-04-02 |