| NPI | 1437583796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95001287) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 752189) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2018-03-17 |