| NPI | 1043049133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 740577) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-08-21 |