| NPI | 1942445796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN210818) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA VN210818) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2010-11-10 |