| NPI | 1689333932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95046624) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95046624) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2021-12-14 |