| NPI | 1376038943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 848893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 848893) |
| 163WA2000X Registered Nurse, Administrator (Licence: CA 848893) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-06-26 |