| NPI | 1437654217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 95114434) |
| Additional Taxonomies | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent (Licence: CA 95114434) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2018-03-26 |