| NPI | 1508258120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 821558) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NM RN79148) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL RN9380542) | |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-04-06 |