| NPI | 1841748670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 171M00000X) |
| 253J00000X Foster Care Agency (Licence: CA 171M00000X) | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2017-04-21 |