| NPI | 1184608291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: KS 74758) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: KS 13-54146-101) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2023-03-07 |