| NPI | 1497086185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9509651) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH 7890) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2021-11-18 |