| NPI | 1205637626 | 
|---|---|
| Entity Type | Individual | 
| Gender | N/A | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant | 
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: DC 163WPO89X) | 
| Enumeration Date | 2025-03-21 | 
| Last Update Date | 2025-05-23 |