NPI | 1447639406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 810778) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 810778) |
Enumeration Date | 2015-05-23 |
Last Update Date | 2015-10-06 |