| NPI | 1447639406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/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 |