| NPI | 1902270259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95171606) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95171606) |
| 164X00000X Licensed Vocational Nurse (Licence: CA VN 280643) | |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2024-11-20 |