| NPI | 1245595529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95259414) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 96247) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2024-04-24 |