| NPI | 1174131981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95271814) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2022-05-10 |