| NPI | 1174528509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: HI RN-20223) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI RN-20223) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI RN-20223) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 422-91) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2007-10-09 |