| NPI | 1225476757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95083829) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2276803) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2016-08-28 |