| NPI | 1851877161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95208022) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 37522) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2021-01-27 |