| NPI | 1144435025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: HI APRN-271) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: HI 1217) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2011-06-20 |