| NPI | 1942730783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CA 95162669) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-07-21 |