| NPI | 1477621944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist Psychiatric/Mental Health, Adult (Licence: MA 184485) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 184485) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-01-05 |