| NPI | 1104137124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: IN 71003266A) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: IN 71003266A) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2017-03-13 |