| NPI | 1235551409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: UT 8820342-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 8820342-1206) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2023-09-07 |