| NPI | 1972703270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 197120-30) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2014-06-03 |