| NPI | 1881136992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: CA 95050262) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 95050262) |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2016-11-07 |