| NPI | 1629617139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95114817) |
| Additional Taxonomies | 163WC1400X Registered Nurse, College Health (Licence: CA 95114817) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2020-03-28 |