| NPI | 1083098859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 225561) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 225561) |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2023-01-05 |