| NPI | 1427159664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CO 180365-5256) |
| Additional Taxonomies | 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: WY 18756.196) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-08-21 |