| NPI | 1497830962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 756959) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 201773) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2009-11-11 |