| NPI | 1669811840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95418079) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 259037) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2025-11-22 |