| NPI | 1568448652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IN 28118429) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: IN 70000141A) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2007-07-08 |