| NPI | 1568403798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: VT 101.0020287) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VT 101-0020287) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0020287) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-11-07 |