| NPI | 1548758295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95117764) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 95117764) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2019-05-24 |