| NPI | 1316098940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: FL 858211) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 858212) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |