| NPI | 1114314671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: CA RN670749) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA RN LIC.# 670749) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2020-11-16 |