| NPI | 1225807597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA RN95334394) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2024-01-30 |