| NPI | 1285206854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: UT 302471-3102) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: UT 302471-3102) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2021-07-13 |