| NPI | 1265817811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95070466) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN 235920) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2016-07-15 |