| NPI | 1518031160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: CT 003018) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IN 71003251A) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-12-07 |