| NPI | 1043254766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: KS 74192) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1454421102) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-08-19 |