| NPI | 1922760958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 685155) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 685155) |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: CA 685155) | |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-07 |