| NPI | 1467159111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022483) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 101084) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2025-12-03 |