| NPI | 1619048840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: CA 650810) |
| Additional Taxonomies | 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: CA 71086) |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2024-03-20 |