| NPI | 1568442226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0000123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DE Q10000671) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2013-12-12 |