| NPI | 1306358064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95375269) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 40627) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2026-08-18 |