| NPI | 1588605257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: WI 4270) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3576125) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2016-06-15 |