| NPI | 1669878401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0807X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent (Licence: RI PPNS00125) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2021-04-30 |