| NPI | 1790042372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA RN821495) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 198801) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2019-04-19 |