| NPI | 1689369654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CO PN.0047189) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO 0047189) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2023-04-06 |