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