| NPI | 1730770090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN95148671) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN95142671) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-03-15 |