| NPI | 1851455232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 439926) |
| Additional Taxonomies | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: CA 439926) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |