| NPI | 1376199463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN95239143) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 675472-1) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2021-03-02 |