| NPI | 1477040434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95338445) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 40634) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2023-10-12 |