| NPI | 1114184892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MO 085700) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |