| NPI | 1316070691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CT 002663) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT R53620) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2023-03-07 |