| NPI | 1346758158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95247211) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 268899) |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2023-05-08 |