| NPI | 1174739965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0807X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent (Licence: FL APRN11025324) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-07-31 |