| NPI | 1255753448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 5396) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: PR 1350) |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2014-01-08 |