| NPI | 1639628621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 624081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 624081) |
| Enumeration Date | 2016-10-02 |
| Last Update Date | 2016-12-26 |