| NPI | 1306195169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 762084) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 78012) |
| 101YM0800X Counselor, Mental Health (Licence: CA 142067) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2024-07-23 |