| NPI | 1013380922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent (Licence: GA RN211713) |
| Additional Taxonomies | 163WC0400X Registered Nurse Case Management (Licence: GA RN211713) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |