| NPI | 1346577376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: VA 0015000702) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001085702) |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2022-01-24 |