| NPI | 1629234182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MD RN135725) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD R135725) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2008-08-18 |