| NPI | 1376175430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95237355) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 697311) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2025-07-11 |