NPI | 1922760958 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 685155) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/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 |