| NPI | 1326000332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C005155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 1703032) |
| 163W00000X Registered Nurse (Licence: NC C0011722) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |