| NPI | 1760129555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: CA 95158154) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95158154) |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2022-05-13 |