| NPI | 1629104500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 95035527) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-08-28 |