| NPI | 1134703960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95200803) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 95200803) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 95200803) | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2021-05-07 |