| NPI | 1366632929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NJ 26NC05968000) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: VT 101.0075954) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2013-04-08 |