| NPI | 1326088188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 598609) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: TX 598609) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-05-06 |