| NPI | 1801308358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95142707) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 95142707) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95142707) | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2023-07-03 |