| NPI | 1346010428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN737661) |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |