| NPI | 1114065869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R066358) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1008295) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: MD R066358) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2010-07-07 |