| NPI | 1366867574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95142918) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 255453) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2017-11-21 |