| NPI | 1720505464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 95111202) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95111202) |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2017-08-24 |