| NPI | 1881147031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 225135) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA VN225135) |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2020-01-08 |