| NPI | 1003890518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: MA 182877) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 182877) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2015-06-24 |